012–Tri-State Program to Provide Diabetes Education to School Personnel

Abstract

Purpose: To provide critical information on automated insulin delivery for pediatric nurses and educators, including youth specific challenges and key questions for clinicians. Description of topic: AID devices in youth with T1D include agespecific challenges: dealing with glucose variability, behavioral challenges, and wearing multiple devices. AID works best in conjunction with good diabetes care practices including accurate blood glucose measurements, especially when calibrating the sensor, and consistent meal bolusing. AID can provide excellent nocturnal glucose control, however AID will not be able to compensate for missed-meal boluses or grossly inaccurate carbohydrate counting. Expectations of patients and families starting these systems need to be realistic and carefully assessed by educators and clinicians. As with all pumps and sensors, good skin care practices should be employed, including use of barrier films, adhesive preparations, and anti-inflammatory products. All stakeholders-patients, parents, school nurses, educators, and providersmust be prepared to answer critical questions with AID systems: How is AID different from Sensor Augmented Pump? Who is the right candidate for AID therapy? How is insulin delivery calculated? How can the user make adjustments safely? What frequency of follow-up do they need? How much of this follow-up can be done remotely? When should the user return to standard pump mode? Clinical implications: For AID to succeed commercially and clinically, diabetes nurses, educators, and providers must be prepared to evaluate candidates for AID and provide realistic expectations. AID, while novel, is not a panacea and will still require good diabetes care practices for successful implementation. Background: Abnormal lipid levels can be caused by genetic mutations that alter regulatory mechanisms of lipid metabolism such as familial hypercholesterolemia (FH), acquired conditions (e.g. high fat, high carbohydrate diet, lack of exercise, obesity, and a variety of medications), or both. When present, FH results in lifelong elevation of LDL cholesterol (LDL-C), significantly increasing the risk of premature cardiovascular disease in adulthood. To identify at risk youth, in 2011 NHLBI published recommendations for universally screening of all youth 9-11 years of age and, if normal, repeat screening at 17-20. Youth identified as having FH should receive appropriate treatment, and relatives offered the opportunity to undergo cascade screening (CS). Purpose: Pediatric nurses play a key role in CS of relatives of individuals with FH. Prior to implementing a CS program in our Pediatric Lipid Clinic, we undertook a literature review to better understand the methods utilized for successful screening, potential barriers, including cost and confidentiality, and effectiveness. Description of topic: FH, a common hereditary disorder (1 in 250), is characterized by greatly increased levels of LDL-C. Individuals with heterozygous FH are at 3-to 4-fold higher risk for coronary artery disease (CAD) an...